Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Early Results of VATS for Spontaneous Pneumothorax

자연기흉에 대한 비디오흉강경수술의 조기성적

  • 김응중 (한림대학교 의과대학 흉부외과학교실) ;
  • 박재형 (한림대학교 의과대학 흉부외과학교실)
  • Published : 1996.07.01
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Abstract

Video-assisted thoracic surgery(VATS) has been widely used in the treatment of spontaneous pneumothorax in spite of the absence of definitive data regarding the relative safety and long term results of this procedure. We reviewed 34 patients (group I) who underwent )8 video-assisted surgical procedures for spontaneous pneumothorax from June 1994 to December 1995 and compared the results of these patients with the results of another 14 patients (group ll) who underwent bullectomy through axillary Oho- racotomy during the same period. Average age, sex distribution, site and extent of pneumothorax, surgical indications, and complication rate showed no differences between the two groups. In group ll patients, th number and sites of bullae tend to be multiple compared to patients in group 1. The mean number of ends-GIA used for stapling of bullae was 2. 6 per patient with the range from 2 to 4 in group 1. The mean duration of chest tube drainage was not different between the two groups ().7 days and 3.9 days), but the mean time to discharge was significantly shorter in group I (5.6 days) than in group ll (8.9 days). Mean follow-up time was 12 and 11 months in each groups and ranged from 2 to 21 months. Pneumothorax recurred after three of 38 procedures in group I (7.9 %) with no recurrence in group ll. These data suggest that video-assisted thoracic surgery is a viable alternative to thoracotomy for the treatment of spontaneous pneumothorax with low morbidity and shorter hospital stay. However, it should be applied cautiously to patients with spontaneous pneumothorax because of the relatively high incidence of recurrence compared to axillary thoracotomy.

최근 비디오흥강경의 발달로 인하여 많은 수의 외과의사들에 의하여 자연기흥에 대하여 비디오흥강 경을 이용한 기포절제술이 적절한 치료법으로 제시되고 있지만 지금까지 이 수술 후의 추적관찰 결과 등에 대하여는 크게 보고된 바가 없다. 저자는 1994년 6월부터 1995년 12월까지 38회의 비디오흥강경을 이용한 기포절제술을 시행받은 자연기흥 환자 34례(1군)를 대상으로 그 수술결과와 조기 추적관찰 결과 를분석하였으며 동시에 이 결과를 같은 기간에 액와절개술을통해 기포절제술을시행받은환자 14례(2 군)의 결과와 비교하였다. 성별, 나이, 기흥의 위치와 정도, 수술적응증, 그리고 수술후 합병증 발생률은 두군에서 유의한 차이 를 보이지 않았다. 그러나 2군에서 1군에 비해 기포의 숫자와 위치가 다발성인 경향이 있었으며 1군에 서 기포절제술시 사용한 자동봉합기의 숫자는 2개에서 4개 사이로 평균 2.6개를 차지하고 있었다. 흥관제거시까지의 기간은 두군에서 차이가 없었으나(3.7일, 3.9일)퇴원시까지의 기간은 1군(5.6일)에 서 2군(8.9일)에 비해 유의하게 짧았다. 수술후2개월에서 21개월까지 평균 12개월의 추적관찰기간중 1 군에서는 3례(7. %)의 기흥재발이 있었으나 2군에서는 기흥의 재발례가 없었다. 이상의 결과로 기흥에 대한 비디오홍강경수술이 액와절개술에 의한 수술보다 덜 침습적 이고 재원기 간이 팎아지는등의 장점이 있으나 수술후 기흥의 재발률이 높은 것으로 관찰되어 이의 적용에는 신중을 기해야 할 것으로 판단된다.

Keywords

References

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